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ease in this garrison, many difficulties, no doubt, arise, which I do not by any means pretend to solve; but merely to state some of those which, in my opinion, militate against the idea of the disease having originated in Gibraltar.
“I find a difficulty, for instance, in viewing it as an endemic proceeding from marsh miasmata, or other noxious exhalations, as a considerable number of persons entirely escaped the disease, although strictly confined to the only situations where I conceive these effluvia may be supposed to exist, the dock. yard and navy garden. I find, too, a difficulty in attributing it to the peculiar state of the atmosphere, at the period of its appearance; for during the number of years that have elapsed since we have held this rock, surely the state of the atmosphere, and supposed prevalence of marsh miasmata, &c. must frequently have been as they were in the years 1804, 1810, and 1813; and I have not heard that a fever of a similar type to that which prevailed during those years is on record. Local circumstances may have varied, no doubt, and concurred in rendering the type of a reigning fever more malignant, such as a great increase of population, crowded dwellings, &c.; but, for some years past, I am informed, there has not been much variation on these heads. I am inclined, therefore, to believe, that this infectious fever was brought into the garrison by a person who died of it, soon after his arrival, it was said, from a place infected previous to his leaving it; and from affidavits on record, it appears that it was introduced in a similar way in 1804; and had it not been for the prompt and vigorous measures pursued, the year 1813 would have exhibited as melancholy a list of victims.
“Jos. D. A. GILPIN, D.I. H. “Gibraltar, December 1813."
Authentic official document (respecting the importation of infection), by a Spanish physician.
“ The following is the mode in which, according to the nicest investigation, the fever was introduced into the garri. son of Gibraltar, in this present year, 1813.
“On the 11th of August, a town xebeque, called the Fortune, whereof was master or patron one Lodovico Bosano, alias VOL. VI.
Molta, arrived from Cadiz. One of the crew thereof being ill, was sent to the Catholic hospital, who died on the 19th of said month, with all the symptoms of the fever now prevalent, namely the yellow-fever.
“ A Frenchman, native of Paris, died on the 3d of September same year, in Governor's street, near City-Mill-lane, with the same symptoms as the former man, and who had also come passenger on board the vessel before alluded to; and, from the 3d of September to the 11th of the same, nine persons died in the neighbourhood. On this day I observed, in the same district, two cases of the yellow-fever, which I instantly reported to Doctors Gilpin and Fraser, who consequently adopted the necessary precautions upon such alarming accidents.
“ It is also asserted, that a gun-boat which came in from Cadiz, about the beginning of August, had some of her crew put on board the prison ship, San Juan, who soon took the infection: this fact will be better elucidated by the testimony of Surgeon Williams, of said prison-ship.
“General Statement of New Cases and Deaths of the Epidemic Disease prevalent in Gibraltar, from the 8th
September to the 4th December 1813.
Military retto. Town. South. Hosps. Totalretto. Town. South. Hosps. Total.
Detail of military deaths.
Observations sur la Nature et le Traitement des Maladies du
Foie. Par ANTOINE PORTAL, Professeur de Médecine au Collége Impérial de France, &c. &c. 8vo. pp. 646. Paris,
1813. [From the London New Medical and Physical Journal, for February, 1815.]
This work on the Nature and Treatment of Liver Diseases is the production of M. Portal, a distinguished physician of Paris. His “ Anatomie Medicale” and other valuable writings, are well known in this island. They reflect honour on his talents and industry; and entitle him to a conspicuous rank amid the more celebrated pathologists of the present age.
Of a book, containing more than six hundred closely printed pages, and treating upon a subject thus comprehensive and important, it will be difficult to institute, within the limits of common criticism, a clear or useful examination. With the principal divisions of the work, we shall notice any prominent or peculiar feature which it may display; present, in a concise form, and stripped of all superfluous ornament, the more instructive and luminous histories of disease, elucidated by dissection; and endeavour to convey to the British reader, a general and correct knowledge of the present state of French theory and practice in morbid affections of the liver.
Conformably to our design, we proceed to lay before the reader the plan, and enumerate the divisions of this important volume.
The work consists of two divisions. Those diseases which are generally acknowledged to affect directly the liver, compose the first.
Under the second division are considered the conditions of the liver in various maladies, which are believed to have their origin in other organs; and which terminate, for the most part, in phthisis of the hepatic viscus (phthisie hépatique). Eight chapters constitute the first division.
The first chapter treats of pains of the liver.
In illustration of this symptom, many cases are borrowed from the writings of respectable pathologists. Two only are cited from our author's practice. Dissection shows that pains of the liver commonly are produced by biliary concretions, ulcers, suppuration, or enlargement of that organ. It is satisfactorily proved, from several of these histories, that numerous, large, and even angular, concretions, may exist in the gallbladder, unaccompanied by jaundice, pain, or other symptom, indicating their presence. Of this fact we have long been convinced. Our author's valuable cases we present with all possible brevity and precision.
A middle aged woman had long been subject to obscure pains in the epigastric region. Much food, mixed with bile and mucus, was evacuated from her stomach by the operation of an emetic; the pain became more severe and constant with frequent nausea. Portal was consulted; and discovered on examination, that the left lobe of the liver was affected. There was great soreness on the lightest pressure. Menstruation was obstructed. Medicine did not relieve. Vomitings, sometimes mixed with blood, succeeded. The epigastric pains were augmented. Fever came on. Food of every kind was rejected. Emaciation, diarrhæa, evening exacerbations of fever, and night-sweats, terminated in death.
Emollient drinks, bathing, and venesection had been employed.
The liver was found of a black colour and softened in structure; particularly the left lobe, which was large, and adhered closely to the peritoneum. The right lobe was externally of a violet colour; and the membrane readily separated from it, as in putrefaction. The pyloric orifice of the stomach was contracted; its circumference thickened. The vena portarum with its branches was full of thick black blood.
A lady experienced for many years pain in the hepatic region; and colic from indigestion. Her complexion was often yellow; urine red; stools gray. The lower limbs became ædematous: pain was felt in the situation of the right kidney. The urine grew turbid, and had at times the appearance of blood. The swelling of the extremities increased. Fluid collected in